Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan.
Department of Surgery, Iwamizawa Municipal Hospital, West 7-2, 9 jou, Iwamizawa, 068-8555, Japan.
Surg Endosc. 2018 Jan;32(1):436-442. doi: 10.1007/s00464-017-5701-z. Epub 2017 Jun 29.
The use of laparoscopic colectomy is becoming widespread and acquisition of its technique is challenging. In this study, we investigated whether supervision by a technically qualified surgeon affects the proficiency and safety of laparoscopic colectomy performed by novice surgeons.
The outcomes of 23 right colectomies and 19 high anterior resections for colon cancers performed by five novice surgeons (experience level of <10 cases) between 2014 and 2016 were assessed. A laparoscopic surgeon qualified by the Endoscopic Surgical Skill Qualification System (Japan Society for Endoscopic Surgery) participated in surgeries as the teaching assistant.
In the right colectomy group, one patient (4.3%) required conversion to open surgery and postoperative morbidities occurred in two cases (8.6%). The operative time moving average gradually decreased from 216 to 150 min, and the blood loss decreased from 128 to 28 mL. In the CUSUM charts, the values for operative time decreased continuously after the 18th case, as compared to the Japanese standard. The values for blood loss also plateaued after the 18th case. In the high anterior resection group, one patient (5.2%) required conversion to open surgery and no postoperative complication occurred in any patient. The operative time moving average gradually decreased from 258 to 228 min, and the blood loss decreased from 33 to 18 mL. The CUSUM charts showed that the values of operative time plateaued after the 18th case, as compared to the Japanese standard. In the CUSUM chart for blood loss, no distinguishing peak or trend was noted.
Supervision by a technically qualified surgeon affects the proficiency and safety of laparoscopic colectomy performed by novice surgeons. The trainee's learning curve in this study represents successful mentoring by the laparoscopic surgeon qualified by the Endoscopic Surgical Skill Qualification System.
腹腔镜结肠切除术的应用越来越广泛，但其技术的掌握具有挑战性。本研究旨在探讨有经验的外科医生的监督是否会影响新手外科医生施行腹腔镜结肠切除术的熟练程度和安全性。
评估了 2014 年至 2016 年期间 5 名经验不足 10 例的新手外科医生施行的 23 例右半结肠切除术和 19 例结肠癌高位前切除术的结果。一名通过内镜手术技能资格认证系统（日本内镜外科学会）认证的腹腔镜外科医生作为教学助理参与手术。
在右半结肠切除术组中，1 例（4.3%）患者需要转为开腹手术，2 例（8.6%）患者发生术后并发症。手术时间的平均值从 216 分钟逐渐减少到 150 分钟，出血量从 128 毫升减少到 28 毫升。在累积和（CUSUM）图中，与日本标准相比，手术时间的数值在第 18 例后连续下降。出血量也在第 18 例后趋于平稳。在高位前切除术组中，1 例（5.2%）患者需要转为开腹手术，无任何患者发生术后并发症。手术时间的平均值从 258 分钟逐渐减少到 228 分钟，出血量从 33 毫升减少到 18 毫升。CUSUM 图显示，与日本标准相比，手术时间的数值在第 18 例后趋于平稳。在出血量的 CUSUM 图中，没有明显的峰值或趋势。
有经验的外科医生的监督会影响新手外科医生施行腹腔镜结肠切除术的熟练程度和安全性。本研究中受训者的学习曲线代表了通过内镜手术技能资格认证系统认证的腹腔镜外科医生的成功指导。
